Diagnostics and history taking in the practice of a cosmetologist

Polina Laiter , cosmetologist, specialist in the field of restorative cosmetology and natural rejuvenation of the face and neck, author of functional aesthetic rehabilitation of face and neck tissues “Layer-by-layer therapy Reface Laitlift System” (Israel)

Side effects and complications

There are three scenarios when working to restore the face and neck after invasive procedures:

• recovery in the presence of side effects;
• recovery in the presence of side effects and early complications;
• recovery from late (many months) complications.

The main goal in restoring the face and neck in the presence of side effects or side effects and early complications is to relieve swelling in a timely manner. It is necessary to create the prerequisites for the swelling to go away as quickly as possible and in all possible ways. That is, you need to do for the body what it itself, for some reason, cannot do or does too slowly.

Why is it important? Since post-traumatic edema creates pressure with its large volume on nerves and vessels, which, for various reasons, do not cope well with their functions, venous and lymphatic outflows are significantly impaired. This contributes to deterioration of tissue nutrition, slower healing and can lead to serious early complications - congestion, congestive hematomas and hyperpigmentation at the site of their occurrence, inflammation, scar deformation, tissue necrosis, etc. This not only worsens the psychological state of the patient, but also affects the final result of the operation.

When correcting side effects and early complications, you should always take into account the qualifications and practical experience of the specialist who treated the patient before you, the technique he chose, the volume and protocol of the intervention, the presence of fillers and botulinum toxin in the tissues, and the quality of the drugs administered.

When we are talking about late complications of plastic surgery, injection or thread treatment, often unexpected and lasting many months, then four more must be added to the listed parameters that influence the patient’s management tactics:

• whether rehabilitation was carried out after the correction, and also how long the recovery period took;
• what condition and position were the subcutaneous structures in at the time of the start of correction;
• what is the ability of subcutaneous structures to recover after injury;
• what functional disorders and cause-and-effect blocks prevented the subcutaneous structures from recovering.

And although the attitude towards early rehabilitation among plastic surgeons is still ambiguous, many still write about the positive impact of timely correction of side effects and early complications on the result of aesthetic effects; protocols for these purposes have already been developed. Little is written about the influence of late complications on the final outcome and duration of the result of aesthetic correction. This topic is complex, not tracked, but, as it turns out, is very relevant for all types of facial aging and especially for the Slavic type.

Case from practice

For clarity, I will give an example of drawing up a rehabilitation program for the tissues of the face and neck in case of a late, many-month complication after blepharoplasty.

On the recommendation of a plastic surgeon, a patient came to the clinic with a complication after blepharoplasty of the upper and lower eyelids. By that time, a year had already passed since the operation.

The complication consisted of a prolonged inflammatory process in one eye. All the measures taken by different specialists during the year did not help the patient. The eye looked very tense, inflamed, enlarged and bulging, closed halfway, there was constant pain and stinging, the eye was watering. Suffering from painful treatments did not correspond to the minor recovery outcome.

After collecting anamnesis, visual and palpation Reface diagnostics, the selected complication correction program included three stages and looked like this:

• carrying out six procedures of functional aesthetic rehabilitation using the author’s method “Layer-by-layer therapy Reface laitlift system”;
• consultation with an ophthalmologist;
• dentist consultation.

The method of functional aesthetic rehabilitation of face and neck tissues “Layer-by-layer therapy Reface laitlift system” should carry out layer-by-layer restoration of facial tissues. At the same time, we work not only with post-trauma (which, of course, can be considered plastic surgery), but also with changes in the position and condition of subcutaneous structures associated with the processes of premature aging.

From the point of view of the concept of the method, the cause of aesthetic deformations and complications is a combination of dysfunctions in the position and dysfunction of the state of connective tissue structures, which are located in different topographic layers (that is, at different depths) and are interconnected into functional blocks “face - body”.

Positional dysfunction is anything that affects the motor pattern (injuries, facial or postural patterns, orthopedic problems, bite problems, etc.). Dysfunction of the condition is anything that leads to premature or biological tissue damage (tissue overstrain, muscle imbalance, edema, fibrosis, tissue sclerosis, lymphostasis, impaired blood flow and outflow).

Some dysfunctions appear prematurely, and this is associated with anatomical problems, injuries, lifestyle and other unfavorable factors, and some are natural stages of physiological processes, that is, biological aging.

Some dysfunctions can be corrected with manual techniques much better than with hardware, injection, or surgery, but some cannot. As well as vice versa. The ultimate goal of rehabilitation is to achieve freedom of movement of subcutaneous structures and liquid media (restoration of the physiological motor pattern) and create conditions for self-healing.

For this patient, work was carried out on all layers of the face and neck. Six procedures were performed.

The ophthalmologist checked the condition of the eye, since numerous injections raised concerns about its condition. After six procedures of layer-by-layer therapy and diagnosis of the condition, the eye had to be sutured for some time in order to create additional conditions for self-healing. The ophthalmologist discontinued all previously recommended numerous medications.

The dentist additionally relieved muscle tension in the masticatory muscle group at night, since one of the causes of the complication was changes in the tone of the muscles of the occlusal unit (the dentist recommended a mouth guard).

With the traditional approach, compensatory changes are often mistaken for late complications, thereby missing the true problem. Hence the possible lack of treatment results. Prolonged inflammation in the eye, which was treated for so long and unsuccessfully in this case, was in fact a response to an unfavorable combination of circumstances: namely, an incorrectly selected and performed blepharoplasty method, which aggravated serious biomechanical changes in the occlusal system, a specific Slavic type of facial aging, large the time period that has passed since the incorrectly performed operation, and incorrectly chosen methods of rehabilitation.

The eye rehabilitation program proposed by the clinic was completed and completed successfully.

Age-related changes

What is premature facial aging from the point of view of the biomechanics of the face and neck?

When a cosmetologist, seeing a photograph of the result of correction of aesthetic deformation using the method of functional aesthetic rehabilitation of face and neck tissues “Layered Therapy Reface Laitlift System,” asks what skin (or injectable) drug I used to achieve this result, what does this tell me? First of all, about the fact that in fact this cosmetologist does not see what is the cause of aesthetic deformation, and what is the consequence or compensation of the process.

The prerequisites for premature aesthetic deformations of the face and neck are not related to age and can be observed both at nineteen and at sixty.

This is a long chain of mutually influencing individual functional disorders that are caused by any injuries, facial and postural patterns, incorrect orthodontic treatment or prosthetics, and even lack of breastfeeding, diction defects, etc. That is, everything that, from the point of view of the biomechanics of the face and neck changes the position, and then, as a consequence, the state of the subcutaneous structures of the face, forming incorrect motor stereotypes.

Everything should move, but something interferes with this movement, forming a pathological motor stereotype. This leads to premature aging of the face and is manifested by asymmetry, “jowls”, changes in the lower third of the face, neck length, aesthetic deformations of the neck, nasolabial folds and some aesthetic deformations of the eye area.

A functional disorder begins in one layer of the face, neck, or body, and the body tries to adapt to it through compensatory impairment in another layer. This creates a mechanism of cause-and-effect blocks that disrupt the movement of liquid media.

Each organism has its own range of adaptive capabilities and its own leading trigger - biomechanical, cranial, psychosomatic, chemical or connective tissue.

In my opinion, quite often there is a substitution of the concepts of “biological aging” (we will all age) and “premature aging” (the presence of triggers that accelerate the process of biological aging). If there are many such triggers, then there will be more functional disorders, therefore, the aesthetic correction of premature signs of facial aging will become much more complicated. By the way, as with long-term complications after invasive procedures.

Diagnostics

To facilitate understanding and determine which triggers led to functional tissue disorders and were the causes of early or late complications after invasion, premature aging of the face and neck, I always carry out diagnostics in several stages: in particular, photographing from four angles, taking an anamnesis, visual and palpation diagnostics.

I always start reface diagnostics by identifying weak areas of the face and shoulder girdle.

Characteristics of six weak areas of the face:

1. Barrier layer of skin (characterized by dryness, flaking, hyperemia, inflammation, redness, sensitivity).
2. Dermal layer of skin (characterized by dehydration, sagging, static wrinkles, yellow undertones, dullness, hyperpigmentation).
3. Lymphatic stagnation (characterized by swelling, pastiness, loose tissue, folds, bags under the eyes).
4. Subcutaneous fat (characterized by hypertrophy, displacement of fat packets).
5. Condition of muscles, bones (characterized by dynamic wrinkles, muscle length (tone), unbalanced tone).
6. Position of muscles, bones (characterized by tractions, asymmetries, overtensions, displacements, problems in occlusion, position of the head and shoulder girdle, postural discomforts).

The first stage is photographing from four angles: standing (front, profile, back) and sitting (front, back) (photos 1–2) When taking photos, pay attention to:

• symmetry of the halves of the face;
• bags under the eyes;
• eye size and symmetry;
• nose width;
• the severity of the chin and nasolabial folds;
• severity of wrinkles;
• the severity of fat bags;
• position of the corners of the mouth;
• presence of pastiness;
• position of the ears;
• head position;
• neck length;
• position of the shoulder girdle and pelvis;
• arm length

The second stage is collecting anamnesis. We ask:

• about the individual characteristics of the patient (age, gender, stress, sleep, sun exposure, etc.);
• whether the patient suffers from systemic diseases and concomitant pathologies (hypothyroidism, diabetes mellitus, hormonal changes, vitamin deficiencies, oncological, hematological diseases, etc.);
• lifestyle features (smoking, alcohol, nutrition, deficiency or excess of vitamins, taking medications, drinking regimen, etc.);
• what is the condition of the sinuses;
• are there otitises, tonsillitis, sinusitis, decreased visual acuity;
• how the patient speaks and moves;
• whether orthodontic treatment or prosthetics was performed;
• whether there are dysfunctions of the temporomandibular joint;
• the presence of fillers, botulinum toxin, threads in the tissues;
• whether (if any, then when) hardware or chemical peelings (deep, medium) were carried out;
• is there any orthopedic pathology;
• what injuries were there;
• whether operations were performed and what;
• what is basic and corrective home care?

The third stage is visual Reface diagnostics in static conditions. We evaluate:

• type of aging;
• degree of gravitational ptosis;
• condition of the epidermis and dermis;
• the presence of wrinkles, folds;
• manner of speaking;
• the presence of asymmetries (height of the eyebrows, nostrils, cheekbones, ear level, chin displacement, shoulder height, bevel of the fronto-occipital region, tilt and rotation of the head);
• presence of injuries;
• bite (correct or incorrect);
• the severity of nasolabial folds (with underdevelopment of the upper jaw) or their smoothness (with excessive development of the upper jaw);
• the severity of the chin fold (with underdevelopment of the lower jaw) or its smoothness (with excessive development);
• orthopedic pathologies;
• the severity of side effects or complications after invasion.

Visual Reface diagnostics of the position of the head and shoulder girdle in dynamics. We evaluate:

• head position (extended, cervical curve straightened, tilted, turned, thrown back);
• shoulder position (raised, lowered, apart, brought together, turned to one side);
• position of the clavicles (symmetrical, the angle of the clavicles is sharp or flat);
• position of the shoulder blades (lowered, separated, retracted, wing-shaped, protruding);
• pelvic position;
• lack of freedom of movement (for example, instead of turning the head, the patient turns his whole body; we evaluate the movement of the lower jaw when speaking);
• how the patient breathes;
• postural patterns of the head and neck in statics and dynamics;
• postural discomfort related to ergonomics * .

The fourth stage is palpation Reface diagnostics. Essentially, this is an examination that determines the degree of tissue change and simultaneous correction.

Why is such a detailed history taking, diagnosis and photographing from several angles necessary? In order to make it clear what functional disorders are masked as aesthetic deformations of the face and neck, as well as what corrective actions, or rather, their sequence, can solve the problem.

A detailed diagnosis is also necessary to make it clear what a cosmetologist can and should do and at what stage of working with the patient it is necessary to involve a related specialist - a nutritionist, a physiotherapist, a Feldenkrais therapist, an orthodontist, a psychotherapist, a plastic surgeon, etc. This understanding is critical, because in many ways it determines both the result and its duration during any aesthetic correction.

***

The first step in correcting premature aging of the face and neck, in the absence of results after aesthetic correction or long-term complications after invasive procedures, in most cases will not be local correction using injection or hardware methods, but Reface diagnosis and restoration of functional disorders and blocks that led to non-physiological (pathological) ) motor stereotype.

Functional aesthetic tissue rehabilitation “Layer-by-layer therapy Reface Laitlift System” transforms a pathological motor stereotype (as a biomechanical cause of premature aging of the face) into a physiological one and thereby helps to slow down the process of biological aging.

* Ergonomics is the science of organizing or designing things for their effective use. Poor ergonomics not only creates direct postural discomfort and tension (for example, when you reach too far for a computer mouse), but also creates bad habits in people (patterns) to adapt to it. For example, computers make many people slouch, heavy bags on the shoulder cause lifting the shoulder on which the bag hangs, chewing on one side provokes overstrain of the masticatory muscle group, sleeping on the stomach causes swelling of the face, tension in the muscles of the neck and back, etc.

Photos courtesy of the author

First published: Nouvel Aesthetic 3 (109)/2018